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Paper short abstract

Undocumented migrants in Italy may donate organs yet are largely excluded from liver transplantation. Based on multi-sited ethnography, this paper reads the paradox as an immunitary logic—managed inclusion of bodies without political belonging—recasting reciprocity, deservingness, and community.

Paper long abstract

Despite constitutional guarantees of emergency care for all persons on Italian territory, liver transplantation remains effectively inaccessible to undocumented migrants, except under narrowly defined “emergency” criteria. Clinically, transplantation is life-saving; in practice, eligibility is tied to a valid residence permit. By contrast, organ donation is not limited by migration status: under Italy’s modified presumed consent system, undocumented migrants may donate organs even though they would almost never qualify as recipients. This paper reads the resulting asymmetry as an immunitary technology that separates protection from belonging—immunitas without communitas

Transplantation is a privileged site for theorizing immunity because it is immunology made social. Graft survival requires immunosuppression and ongoing surveillance of rejection—the managed incorporation of biological alterity—while allocation and eligibility regimes decide whose alterity can be institutionally accommodated and whose must remain outside.

Drawing on a qualitative multi-sited ethnography of the Italian transplant system, I show how clinicians act as street-level bureaucrats, translating legal and clinical rules into decisions under ethical uncertainty and organizational constraint. Discretion concentrates in donor consent and kin recognition: whether to contact relatives, how to do so, and who counts as “family.” When kin are distant, legally precarious, or culturally misrecognized, providers improvise criteria that often hinge on moral judgments of deservingness. The outcome is a reversed reciprocity: migrants are largely excluded from cure in life yet rendered biologically useful in death. The paper calls for renewed ethical scrutiny of access, reciprocity, and inclusion in transplant governance.